The Political Economy of Healthcare in Nigeria: Diagnosing the Structural Barriers to Reform and Equity

The persistent underperformance of Nigeria’s healthcare system is routinely attributed to technical deficiencies in funding and infrastructure. This systematic review (2013-2024) contends these are symptomatic of a deeper political-economic pathology. Employing a rigorous PRISMA-guided methodology, we synthesized 78 scholarly and policy documents to diagnose the structural barriers constraining meaningful reform. We argue the sector’s dysfunction is a direct consequence of a self-reinforcing vicious cycle, driven by three interconnected mechanisms: a governance quagmire , where federal fragmentation is strategically used to diffuse accountability; a financing paradox , where chronic underinvestment reflects a rational political calculus rather than fiscal constraint; and an implementation gap , where technically sound policies are systematically hollowed out by vested interests and institutional inertia. The analysis advances a novel integrative model, synthesizing Public Choice, Historical Institutionalism, and Political Settlements theories to demonstrate how micro-incentives, historical legacies, and meso-level power dynamics functionally interlink to reproduce systemic failure. The COVID-19 response is presented not as an anomaly, but as a validation of this pre-existing pathological equilibrium. The article concludes that sustainable health system transformation is unattainable without directly confronting these embedded political-economic realities. It thus moves beyond technocratic critique to propose a strategic reorientation towards politically-informed interventions, thereby providing a critical diagnostic framework for understanding policy inertia and founding actionable strategies for equity and reform.